Permanent…?

Everybody around here introduces me as “the new permanent doctor.” When I first heard it, I thought they were joking about how I would just end up staying forever. But then when I laughed, no one else laughed… self conscious that I laughed at a non-joke, I asked “what do you mean?” I learned that because of the high rate of turnover and Locum Tenens (temporary) docs, even my two-year contract is considered permanent. Long-term investment means a lot to the community here, and to building relationships and being trusted. It makes me feel like I want to commit to longer, to guarantee that I’ll be around more “permanently”…but I’m afraid to.

Carved bone man

As much as I love it here already, I am bracing myself for the challenges that I know lie ahead. I realize I have no authority to speak on these things, and yet I think about them a lot as I hear and see providers suffering from burn-out that is multifactorial: including (but not limited to) difficult location, remoteness, scary medical crises, less access to specialists for help with care, the ruggedness, the bitter cold, the expenses, a place like Siberia that drives people to escape and/or warm up with a stiff drink. Not to mention working within a different culture that has more than its share of a traumatic history~~from prospectors exploiting the lands to missionaries disapproving (and in many cases stripping away) cultural beliefs and practices, to the government forcing the natives to take on a different culture. Many native Alaskan children were sent to boarding schools in other states and thousands of others were adopted out without their parents consent, to grow up “civilized” where they became out of touch with their people, then they tried to return “home”–which was fraught with difficulty for them and their tribe, who now perceived them as an “outsider.” Beautifully expressed in this song by Jerry Alfred & the Medicine Beat: “Nendaa – Go back.” Listen here: 

Ivory bone kayak

Imagine not belonging–being stuck in the outside space between your two worlds.

In orientation we learned specifically about the three language groups ~ the Inupiat, Siberian Inupiat and Yupik ~ and the loss of culture, languages, community, belief systems (that are only now starting to be re-taught in schools and recognized with value). But the loss  led to a deeper loss of way, of identity, dignity and sustainability. In turn, every following generation has suffered, leading to more suffering=intergenerational trauma. Impossible to put the pieces back together they way they were. and everyone tries, and the government gives lots of benefits and money back to the people, which seems to cause other problems in different ways…

Unfortunately, we can’t undo what was done. And the biopsychosocial factors affecting health are often complicated and hard to unburden to try to help heal. The things that are most frequently discussed are alcoholism, domestic violence, child abuse, perceived entitlement, the requests for narcotics, the (understandable) mistrust. Fortunately, however, being in rugged, “out-of-the-way” Alaska meant that it took longer for much of the cultural destruction to arrive, compared to the Lower 48. So a lot of culture did remain intact, connected, and community leaders are striving to bring back their roots, to empower youth and adults alike to hold onto and to relearn their culture, to become leaders and caretakers of their community. I work with the most awesome nurses, who are predominately from this region, and who bring so much understanding to all of us.

It’s tough in many ways…and I haven’t even begun to really, deeply, internally understand them all. But then I think about some of the history and reasons why it’s tough, and it gives me further resolve to not only stay as long as possible, but to also always practice from a place of compassion and love. And to do the best I can, but also not to hold on to outcomes. To not have to create or reach a certain endpoint. To let go. And to deeply care about my fellow human beings, who at the end of the day are all the same–part of this beautiful, sacred, fragile, hope-filled, loving, complicated human race.children

Highlight of the day: getting to do radio traffic with a surgeon who comes for 2-3 months at a time a couple times a year. Although he has a tough, cynical veneer and will tell you everything that is hard about this place, he is here for great reasons. And when he gets to talk about them, it is clear that he loves it here and will keep coming back even though he is retired. :) Also, I get to be “the” doc on radio traffic tomorrow. Just like the kiwi radio doctor in PNG…except with waaaaayyy less experience under my belt!

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